Application of behavioural sciences teaching by UK dental undergraduates

From 1990, Behavioural Sciences have become a requisite subject of dental undergraduate curricula across the UK (2). However, subject matter taught varies from school to school (4). The aim of this study was to determine the views and experiences of senior dental undergraduates in applying their behavioural sciences teaching across a range of clinical situations. A questionnaire survey was designed in which 5 UK Dental Schools were included to provide a countrywide geographic distribution and where >75% of senior students in each Dental School participated. The questions required the students to evaluate their psychosocial skills in 4 main areas: dentist/patient interactions; enhancing preventive behaviour; anxiety management; coping with personal stress. 252 students participated, 43% were male. In general, students valued their behavioural sciences teaching and 84% rated its inclusion in the curriculum as important. Some patient management situations had been infrequently encountered in their clinical experience and their confidence in dealing with these situations was low. The data was entered into a stepwise logistic regression to determine which factors explained the variation in reported confidence. In relation to dentist-patient interactions and preventive aspects (9 aspects), significant variables were how well students felt they were taught and how often they encountered the situations. Gender contributed to explaining variation in 4 of these aspects. In dealing with patient aggression, men were over 7x more confident than women (Odd's ratio 7.32), but in changing patients' attitudes to oral health, women were more than 2x as confident as men (Odd's ratio 2.08). In anxiety management and dealing with personal stress, additional variables entered the model and these were age, gender and Dental School. For most aspects of confidence in anxiety management, the quality of teaching to manage these situations was the key variable. In conclusion, this survey has provided an evaluation of UK students' perceived psychosocial skills in a range of clinical settings. This should encourage educators to improve curricular content to support the development of clinical competency in this area.     

创建口腔医学教学新模式的实践与研究

口腔医学教学必须通过改革教学模式,培养更能适应时代发展的应用型口腔医学人才。本课题主要针对教学内容和教学方法、考试测评、论文综述水平进行实践和研究,对于有效地提高口腔医学专业学生的临床应变和分析能力、科研能力有很大的意义,对于口腔医学本科学生综合素质的提高,适应经济发展和社会进步的需要有着深远的意义。     

The effect of a community dental service outreach programme on the confidence of undergraduate students to treat children: a pilot study

OBJECTIVE: To examine the effect of a community dental service (CDS) outreach teaching programme on undergraduates' confidence to undertake a range of paediatric dental procedures. METHOD: Eighteen final year dental students completed a questionnaire prior to, and following participation in an outreach teaching programme. At each time point, the students were asked to identify how confident they felt to carry out a range of procedures commonly encountered in the treatment of children, employing a Likert scale modified to comprise six points where a rating of 1 represented 'not at all confident' and a rating of 6 'very confident'. RESULTS: The distribution of scores at each time point indicated that students were more confident to carry out each of the listed procedures following participation in the outreach teaching programme than they had been on completion of their paediatric dentistry sessions within the School of Dentistry. At the individual student level, 16 of the 18 students indicated that they were, overall, more confident following their placement than previously. CONCLUSIONS: It can be concluded that the long-established CDS outreach teaching programme run by the School of Dentistry, Wales College of Medicine in conjunction with the staff of Cardiff and Vale NHS Trust is a valuable adjunct to undergraduate teaching in paediatric dentistry.     

Deficits in perceptions of oral health relative to general health in populations

OBJECTIVE: To compare perceptions of general health versus oral health within two populations. METHODS: Secondary analysis of cross-sectional survey data obtained from representative samples of dentate adults in Australia and the United States. Australian data were collected in the 2002 National Dental Telephone Interview Survey and United States data were from the NHANES, 1988-1994. A stratified analysis compared self-ratings of general and oral health among groups classified by age, socioeconomic status and access to dental care. RESULTS: In Australia, 43.6% rated their dental health 'very good' or 'excellent' whereas 58.6% rated their general health 'very good' or 'excellent'--a deficit of 15.0%. In the US, there was a comparable deficit of 24.2%. The deficit could be explained as a 'generation gap' where oral health ratings of the youngest cohort resembled the general health ratings of middle-aged adults in Australia and retirees in the US. An 'affluence gap' was evident where the oral health ratings of wealthier adults resembled the general health ratings of disadvantaged adults. Among Australians with private dental insurance who had visited a dentist in the past year the oral health deficit was negligible. Similar stratification in the US sample considerably attenuated the deficit. CONCLUSION: There is a deficit in perceived oral health compared with general health at all stages of adulthood and spanning the socioeconomic spectrum. The deficit was diminished among insured adults who had made a dental visit within the preceding year, suggesting that improved access to dental services may help redress the discrepancy.     

The retention of suturing skills in dental undergraduates

Background: The ability to place sutures is an essential skill in dentistry. In our institution, the introduction of a video teaching aid and a checklist‐based assessment has improved the standardisation of teaching as well as the transparency and objectivity of the assessment of suture skills. The aim of this study was to determine whether this skill once acquired is retained in the short term. Materials and methods: The same cohort of 67 fourth‐year students performed the same assessment at two different time points 2 months apart. The first was a formative assessment and the second was a summative assessment. Feedback was collected on both occasions. Results: On the first sitting of the assessment, 93% of the students were successful compared with 79% on the second occasion. Student feedback was similar on both occasions with 77% and 75% reporting that they thought it was an easy exam. On the first occasion, 27% thought that it was a stressful examination compared with 43% on the second occasion, which may have affected their performance. Conclusions: These findings suggest that regular reinforcement is required to avoid deterioration of suturing skills even in the short term. This might involve exposing the students to surgery earlier in the course and introducing regular formative assessments which the students appear to associate with less stress.     

A pilot study of the use and perceived utility of a scale to assess clinical dental teaching within a UK dental school restorative department

Introduction:  Feedback on individual teaching performance gives an important contribution and support to the reflective practices of educators. Unfortunately, feedback is an infrequent exercise provided to dental teachers about their teaching practices. The Effective Clinical Dental Teaching (ECDT) scale has been used previously to assess clinical teachers, but has not been used within the UK.
Methods:  This study looks at the use of the ECDT scale in the setting of a UK dental school, as a method of feedback collection and delivery in seven domains of clinical teaching. The ECDT was used to evaluate the teaching of 16 clinical teachers by dental undergraduates, and to investigate the opinions of these clinical teachers and clinical dental students about the utility of this scale.
Results:  The study identified that there was a disparity between self and student perception of teaching. The total ECDT scores ranged from a minimum of 55% 66.6/125 to a maximum of 90% 113.8/125, with a mean group score of 73% 91.6/125. Most clinicians evaluated by students scored above 3/5 for all teaching domains, although there appeared to be significant differences between the four teacher groups. The majority of staff and students were in favour of the use of such a scale to support the progression and development of teaching styles.
Conclusion:  The ECDT scale is a useful tool for highlighting the areas of strength and deficiency within clinical dental teaching. Its use may complement peer review for individual teachers and identify future topics for staff development sessions. Further research is recommended to identify the individual strengths and weaknesses that different types of teacher may bring to curriculum teaching.     

Transition of a traditional pharmacology course for dental students to an online delivery format: a pilot project

The purpose of this report is to describe the rationale and subsequent transition of a pharmacology course for dental students from a traditional face-to-face lecture format to online delivery using a course management system (CMS). A dental school faculty member with dental and pharmacology degrees and a Ph.D. was asked to serve as course director and to develop and implement a nontraditional course using the Blackboard CMS technology, which houses asynchronous course content materials, study guides, and online resource materials. Respondus software was used to create, manage, and administer weekly online quizzes. A comprehensive midterm and final examination were conducted in a traditional face-to-face setting. A survey was used to capture student satisfaction with this self-directed introductory pharmacology course. Participants were second-year dental students (Classes of 2011 and 2012). There was a survey response rate of 91 percent (179/197). The Likert-style survey questions produced ordinal data from which the median and interquartile range were calculated. On a scale in which 1=Poor, 5=Excellent, the median evaluation for the instructor was 4 (IQR=1.5). On a global question that asked how students rate the course overall, the median score was 4 (IQR=1.0). Results show that a majority of students were positive about the online delivery of the introductory pharmacology course and for many students this was their first online course experience. Resistance to self-directed learning was a theme with those students who rated the course poorly. In a comparison of overall course grades from the previous year, student performance in this course was much stronger. As a result of student feedback seeking more interaction with the course director, it was determined that the next time the course is offered there will be additional opportunities for greater face-to-face time with the instructor. Ongoing evaluation will be important as new teaching technologies emerge and are adopted for teaching and learning.     

Dental students' knowledge of human immunodeficiency virus

OBJECTIVE: This study evaluated final year dental students' knowledge of human immunodeficiency virus (HIV), lesions associated with HIV, potential transmission routes of HIV, and their perception of the teaching received on cross-infection precautions, virology, sterilization practice and procedure, barrier dentistry and recognition of blood-borne virus risk group. METHODOLOGY: Structured questionnaires on knowledge of human immunodeficiency virus were filled by final year dental students of University of Lagos, Nigeria. A total of 35 out of 37 questionnaires were returned filled giving a response rate of 94.6%. RESULTS: Most of the students rated the teaching they received on cross-infection precautions, sterilization practice and procedure, as adequate. More than a quarter (28.5%) of the students rated the teaching they received on virology and recognition of blood-borne virus risk group to be less than adequate. Most of the students were able to recognize the association of oral Kaposi sarcoma, oral candidiasis, oral hairy leukoplakia, and salivary gland enlargement with HIV infection. There was a much lower level of knowledge of oral melanotic hyperpigmentation and idiopathic thrombocytopaenic pupura. Their knowledge of HIV and its potential transmission routes were adequate. CONCLUSION: This study revealed that final year dental students of the University of Lagos in southwestern region of Nigeria had adequate knowledge of routes of transmission of HIV in clinical practice. However, there is need for improvement in teaching of the students on virology and recognition of blood-borne virus risk group.     

A proposal for a problem‐oriented pharmacobiochemistry course in dental education

Problem‐oriented learning is an effective method of learning that increases students' learning motivation, improves the relationship amongst students and results in open‐minded discussions. In this study, a new problem‐oriented pharmacobiochemistry course related to ‘oxidative metabolism of drugs by cytochrome P450 (CYP450) systems’ was designed. Students were divided into seven groups. Three keywords related to drug interaction through CYP450 were provided to each group in order for them to conduct research on the information given. After 1 month, the groups attended a session under the supervision of a tutor to solve a simulated problem case that was designed using the keywords. At the end of the integrated course, a multiple‐choice examination was given. The success rate of 76 students who attended the course was found to be significantly higher than the success rate of the students who received the lecture‐based course only (P < 0.0001). A questionnaire containing 20 items (Cronbach's alpha: 0.92) was administered to the students to learn about their perception regarding this educational model. The questionnaire was evaluated using the Likert scale. Student feedback was very positive, with fourteen answers rated as ‘agree’ and the remaining six rated as ‘strongly agree’. Students thought that the problem‐oriented model was very enjoyable and useful in regard to dental education. Based on these results, we conclude that this course model may help achieve an integrated curriculum for dental school programmes.     

A review of teaching of behavioural sciences in the United Kingdom dental undergraduate curriculum.

In 1990, the GDC published its recommendations on the teaching of behavioural sciences. A study of sociological and psychological teaching in the dental undergraduate curriculum has shown a great deal of variation between the 14 dental schools in the United Kingdom. Most of this teaching was also theoretical and at a pre-clinical level. Should skills and applied psychology be given an increased emphasis in the core clinical content of the undergraduate curriculum?     

Dental education at The University of Adelaide: an evaluation

A bstract — Dental students, staff, and practitioners participated in an evaluation of the dental curriculum at The University of Adelaide between 1978 and 1981. The need for curriculum reform was expressed by all three groups, especially with respect to the teaching of basic sciences, some biomedical subjects, behavioural science, and practice management. Dental staff and practitioners have also indicated serious misgivings about the quality of clinical skills of new graduates. Proposals for reform are directed to resolving these and other curriculum problems revealed in the evaluation.     

Dental students' views on their education and study circumstances in Nordic countries

The curricula at the Nordic dental schools are similar in their content but may vary in the placement of different subjects and the way of teaching them. The aim of this study was to analyse Nordic dental students social background, and their reasons for choosing dentistry, their opinions on the course, and their future professional plans. A combination of an open-ended and structured questionnaire was given to final year dental students at the dental schools in Aarhus, Bergen, Kuopio and Stockholm. The response rate as 83%. The main reasons for choosing dentistry were its combination of theory and practice (29%), and a wish to work with people (20%), whereas only 4% mentioned the "high status" of the profession. Regular day-time work was emphasized by female students. Most students considered the teaching load heavy. The time devoted to the different subjects was considered sufficient, except for behavioural science and medicine, where the time was too short. There was general dissatisfaction with the teachers pedagogical skills, and there was a feeling that teaching was regarded as secondary to research. Most students planned to become private practitioners. Between 25-55% of the students wanted to specialize, and oral surgery was the most popular specialization.     

Comparison of the instructional efficacy of an internet-based temporomandibular joint (TMJ) tutorial with a traditional seminar

There has been growing interest in the use of virtual learning environments (VLEs) by universities over the past decade to supplement traditional teaching methods. In this study a tutorial providing information about the temporomandibular joint (TMJ), temporomandibular disorders and teaching of a thorough TMJ examination was developed on a VLE platform to enable students to enhance their examination and diagnostic skills. The success of this VLE tutorial was compared with conventional teaching by a cross-over trial. Thirty students were initially randomly allocated to one of two groups; Group 1 completed the VLE tutorial and Group 2 attended the face-to-face seminar in the first instance. The groups then crossed over and had the other method of teaching provided. The findings from the cross-over trial and the students' feedback indicated that no differences were found between either teaching modes, and both are equally effective at delivering information to students. In addition, the order in which the students received the teaching did not make a difference, but giving the teaching twice reinforced their knowledge. There is a strong case to be made for introducing clinical lectures on a VLE platform, and this form of e-learning is, in general, well perceived by new generations of students.     

Teaching and assessing behavioural techniques of applied relaxation for reduction of dental fear using a controlled chairside simulation model

This paper describes a novel method of teaching and assessing relaxation techniques using a controlled chairside simulation model. 50 pre-clinical dental undergraduates provided an evaluation of the teaching model as part of their basic clinical skills teaching. Students were required to demonstrate applied relaxation techniques according to 2 pre-selected clinical vignettes. Inter-observer reliability of assessing student competence was calculated on a varied sample (n=9) using 2 independent observers and found to be adequate. The majority of the students viewed the teaching and assessment method as interesting and clinically relevant. However, a few students reported that the method was less advantageous than using a real patient. It is concluded that using vignettes as part of clinical training accompanied by video-based feedback provides a resourceful learning tool for pre-clinical teaching in the absence of patient contact.     

Advice for the dental team on coping with the nervous child

It is increasingly recognized that the provision of dental care should not be seen in isolation from the psychological make-up and social background of the patient. The General Dental Council has recently approved the report of its Working Party giving guidance on the teaching of the behavioural sciences (psychology and sociology) in the dental curriculum. One of the members of the Working Party was Professor Keith Millar. In this five-part series edited by Professor Millar we will cover the practical application of behavioural science in dentistry, covering communication with patients, ways to change your patients' behaviour, the management of anxious adult and child patients, and stress in dentistry. This first article offers some advice on coping with the nervous child.     

Comparing the effectiveness of the mini-lecture technique to role-playing in a dental psychology course.

The array of instructional methods utilized in teaching behavioral sciences to dental students has included both teacher-centered and student-centered approaches. The purpose of this study was to evaluate the effectiveness of two small-group treatments, mini-lecture and role-playing, in teaching dental psychology. Freshman dental students were randomly assigned to 12 groups. Groups were then assigned to one of six dentist-pyschologist teaching teams so that each team taught one mini-lecture and one role-playing group. Teaching teams taught seven sessions in which each mini-lecture/role-playing pair of groups received parallel subject matter. Following instruction, two outcome measures were administered: (1) an achievement post-test measuring factual recall, and (2) a measure of facilitative communication. Results indicated that mini-lectures were more effective than role-playing in effecting student mastery of factual information. There were no significant differences between the instructional treatments in teaching facilitative communication skills.     

Microbiological status of root-filled teeth with apical periodontitis

The present study examined the microbiological status of 100 root-filled teeth with radiographically verified apical periodontitis — the pathology (P) group — and of 20 teeth without signs of periapical pathosis — the technical (T) group. In the P group 117 strains of bacteria were recovered in 68 teeth. In most of the cases examined one or two strains were found. Facultative anaerobic species predominated among these isolates (69% of identified strains). Growth was classified as 'sparse' or 'very sparse' in 53%, and as 'heavy' or 'very heavy' in 42%. Enterococci were the most frequently isolated genera, showing 'heavy' or 'very heavy' growth in 25 out of 32 cases (78%). In 11 teeth of the T group no bacteria were recovered, whilst the remairling nine yielded 13 microbial strains. Eight of these grew 'very sparsely'. It is concluded that the microflora of the obturated canal differs from that found normally in the untreated necrotic dental pulp, quantitatively as well as qualitatively. Nonsurgical retreatment strategies should be reconsidered.     

The validity and reliability of a clinical performance rating scale

Rating scales are standard tools for evaluating clinical performance in medicine; however, in dentistry they appear to be used solely to evaluate technical skills. A pretest of three performance scales did not reveal the superiority of any one scale, though faculty clearly preferred a 20-item, six-point Likert scale that rated personal, interpersonal, and professional qualities. Directors and co-directors of six group clinics subsequently rated performance of two classes of seniors and one class of juniors. Interrater reliabilities, ranging from .62 to .83 across rater pairs, were superior to reliabilities reported in medical education studies. Although technique grades, preclinical GPA, and performance ratings differentiated students who completed clinical requirements on time (n = 302) from those who did not (n = 83), performance ratings added information about competence that was not reflected in GPA and technique grades. The usefulness of a rating scale appears to be in its potential for giving students feedback and for evaluating program effectiveness.     

Reliability of radiographic observations recorded on a proforma measured using inter- and intra-observer variation: a preliminary study

AIM: The aim of this preliminary study was to test the reliability of radiographic evaluation of features of endodontic interest using a newly devised data collection system. METHODOLOGY: Twelve endodontic MSc postgraduate students and one specialist endodontist examined sample radiographs derived from a random selection of 42 patients seen previously on an Endodontic New Patient Clinic (EDI). Each student examined a random selection of 8-9 roots on periapical radiographs of single- and multirooted teeth, with and without previous root canal therapy and 3-4 dental panoramic tomograms (DPTs). A total of 100 roots were examined. A proforma was used to record observations on 67 radiographic features using predefined criteria. Intra-observer agreement was tested by asking the students to re-examine the radiographs. The principle investigator and the specialist endodontist examined the same radiographs and devised a Gold Standard using the same criteria. This was compared with the student assessments to determine inter-observer variation. The postgraduates then attended a revision session on the use of the form. Each student subsequently examined 8-9 different roots from the pool of radiographs. A further assessment of inter-observer variation was made by comparing these observations with the Gold Standard. RESULTS: Of the 67 radiographic features, only 25 had sufficient response to allow statistical analysis. Kappa values for intra- and inter-observer variation were estimated. These varied depending on the particular radiographic feature being assessed. Fifteen out of 25 intra-observer recordings showed 'good' or 'very good' Kappa agreement, but only three out of 25 inter-observer observations achieved 'good' or 'very good' values. Inter-observer variation was improved following the revision session with 16 out of 25 observations achieving 'good' or 'very good' Kappa agreement. CONCLUSIONS: Modification to the proforma, the criteria used, and training for radiographic assessment were considered necessary to improve the accuracy and reproducibility of the observations entered.